Instrumental Activities Of Daily Living Items Research Articles

Factors Contributing to Health Deterioration in the Japanese Long-Term Care Insurance System in Terms of Instrumental Activities of Daily Living

This study aimed to determine which instrumental activities of daily living (IADL) are associated with health deterioration from the “support level” to the “care level” among users of the long-term care insurance system in Japan. From April 2017 to March 2020, we conducted a retrospective follow-up survey on 178 Japanese community-dwelling older adults (64 men, 114 women) newly certified as support level. Independent variable was 8 IADL items and the outcome defined as the “support level maintenance time.” Cox models were used to assess the risk of health deterioration, with adjustments for age group, family composition, dementia status, and frailty status by gender. Dependence on 5 items, “laundry” (hazard ratio [HR] =2.5; 95% confidence interval [CI]: 1.1-5.8), “cooking” (HR = 3.7; 95% CI: 1.1-12.2), “telephone use” (HR = 2.4; 95% CI: 1.2-4.7), “financial management” (HR = 2.5; 95% CI: 1.2-5.0), and “medication management” (HR = 2.4; 95% CI: 1.2-4.8), was independently associated with a worse outcome among men, whereas dependence on “financial management” (HR = 2.6; 95% CI: 1.5-4.7) and “medication management” (HR = 2.0; 95% CI: 1.1-3.5) was independently associated with a worse outcome among women. These findings suggest that difficulties in “financial management” and “medication management” are common factors associated with health deterioration from the support to the care level among both genders. An association with household tasks was also seen among men, indicating that a paradigm shift is needed to increase the participation of men in household tasks.

Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study.

Increases in dependence among older adults cause increases in care needs and social care burden. Instrumental activities of daily living (IADL) are often used to assess the independence of older adults residing in communities. Various factors affect IADL limitations, but few studies confirm gender differences in IADL limitations in older adults. This study explored the changes in incidence of IADL limitations across 14 years and identified the factors associated with IADL limitations according to gender among older adults in Korea. This study uses secondary data analysis with 2006-2020 data from the Korean Longitudinal Study of Aging (KLoSA), a longitudinal cohort study. Among the total 10,254 participants, 1,230 adults aged 65 years and over who met the criteria were included in the final analysis. For each IADL item, a limitation was defined when the response was partial or complete dependence. Multivariate logistic regression was performed to identify the factors (in 2006) associated with IADL limitations in 2020. The mean age of the participants at baseline was 69.64 years (SD 3.93), and 61.0% of participants were female. Total scores for IADL limitations increased gradually across 14 years in all participants, and observed changes were statistically significant. The top three ranked items of IADL limitations differed according to gender in 2020: the top limitations in men were preparing meals, laundry, and using public transportation, and the top limitations in women were using public transportation, going out, and handling money. Factors associated with total IADL limitations were grip strength in men and age, dementia, fear of fall, and grip strength in women. Factors associated with the top three ranked items of IADL limitations differed according to gender. The incidence of IADL limitations gradually increased in all participants over a 14-year period. In older adults in Korea, gender differences were confirmed in the factors associated with IADL limitations, as well as in the main limited activities. To minimize IADL limitations in community-residing older adults, it is necessary to plan tailored interventions.

66 Association of Executive Functions and Instrumental Activities of Daily Living in Parkinson’s Disease

Objective:Executive function (EF) abilities tend to decline with age, and disproportionately so for people with neurodegenerative disorders such as Parkinson’s Disease (PD), where EF deficits are commonly seen in the early stages of the disease. Due to their nature, EF are essential for performing tasks of daily life, particularly for the more complex instrumental activities of daily living (IADL), and deficits can impair the ability to execute IADL in PD participants. The aim of this study was to examine how EF impairments relate to IADL deficits in both healthy elderly controls and PD participants.Participants and Methods:Seventy-four participants with idiopathic PD and 66 elderly controls were recruited. All participants were non-demented. A comprehensive neuropsychological assessment was administered including the following measures of EF: Hayling Sentence Completion, Brixton Spatial Anticipation, Trail Making Test A and B, Stroop Color-Word Test, Symbol Span (Wechsler Memory Scale-III), Digit Span (Wechsler Adult Intelligence Scale-III), F-A-S test, and Semantic Fluency (Animals and Actions). Z scores were calculated from respective test manuals. Independence was measured using the 8-item Lawton IADL Scale where items are coded from 0 (dependent) to 1 (independent) and the total score ranges from 0 to 8. Motor impairments were assessed using Part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Regression models were run with each cognitive measure as the dependent variable, with group (control vs. PD), age, sex, education, and motor severity as predictors, to examine the effect of group on each cognitive variable. Correlations were then run between the total IADL score, demographic variables, and cognitive variables for each participant group separately to identify the relationship between IADL and EF measures.Results:PD participants were predominantly males (n=51, 68.9%), with an average age of 70.64±6.03 and 15.22±2.78 education years. Controls were predominantly female (n=34, 51.5%) and had an average age of 71.19±7.75 and 15.85±2.82 education years. Regarding IADL function, all participants were relatively independent in their IADLs (PD: 7.72±0.69, range 4-8, Controls: 7.98±0.13, range 7-8). The most difficult IADL items for PD participants were shopping (8.2% dependent) and food preparation (12.2% dependent). When correcting for age, education, sex, and motor severity, only the Stroop Interference z-score was significant for participant group (b=0.44, t=2.14, p=0.034), where controls had slightly lower scores (-0.33±0.77) than PD participants (-0.31±0.91). Correlations in controls were significant between IADL total score and Hayling trials 1 (r=0.35, p=0.005) and 2 (r=0.33, p=0.008), and semantic fluency actions trial (r=0.34, p=0.006). In PD participants, IADL total score was only correlated with semantic fluency (animals trial, r=0.26, p=0.028).Conclusions:There were only weak associations between EF abilities and IADL in both healthy controls and PD participants, suggesting that impairments in EF do not necessarily translate into worse ability to execute IADL in PD. More correlations were found in the control group, which may be confounded by the inclusion (in both groups) of participants who already had cognitive impairment. This highlights a further need to examine whether EF impairments in people with PD influence IADL functioning above and beyond normal aging and whether specific deficits have more real-life consequences not attainable through IADL questionnaires.

Age trajectories of disability in middle and older age: a machine learning approach

Abstract Background The study employed machine learning methods to explore age trajectories of Instrumental Activities of Daily Living (IADL) disability in a representative cohort of middle- and older-aged individuals. This is crucial for understanding the impact of disability onset on healthy life expectancy (HLE) across sub-populations. Methods We utilized data from the Taiwan Longitudinal Study on Aging, which included 5,334 individuals aged 50 and over from 1996 to 2011. To investigate the change in physical functions, we focused on the 6 IADL items assessed over five waves of surveys. Each IADL item was dichotomised and summed to calculate a disability score ranging from 0 to 6 based on its difficulty level. We used K-means clustering to identify IADL disability trajectories and applied 10-fold cross-validation, repeated ten times, to select the optimal classification. We transformed the identified groups into age trajectories based on the mean IADL score at each age within each group. The age trajectories were then smoothed using locally estimated scatterplot smoothing and generalized additive models. Results We identified four trajectory groups based on changes in IADL scores over 15 years: (1) individuals who remained consistently able, (2) individuals with persistent and slower decline, (3) individuals with persistent and faster decline, and (4) individuals with persistent disability. The proportions of the four groups were 56.1%, 20.0%, 16.1% and 7.8%, respectively. The average posterior probabilities for all groups were above 83.3%. The results of this study were comparable to those of traditional regression-based models. We also analyzed the associations between trajectory group membership and participants’ characteristics at baseline. Conclusions This machine learning approach based on K-means clustering is valuable for investigating diverse disability trajectories within the population and can inform future research to explore factors that may enhance HLE. Key messages • Machine learning enables investigating disability trajectories across sub-populations. • The study identified four distinct disability trajectory groups using K-means clustering, providing insights into factors for enhancing healthy life expectancy.

Association of pre-stroke frailty and health-related factors with post-stroke functional independence among community-dwelling Chinese older adults

ObjectivesFrailty is associated with a range of poor post-stroke outcomes. There is still a lack of comprehensive understanding of the temporal relationship between pre-stroke frailty status and other related factors with functional recovery after stroke. This study aims to evaluate pre-stroke frailty status and health-related factors associated with functional independence among community-dwelling Chinese older adults. Materials and methodsThe dataset based on the China Health and Retirement Longitudinal Study (CHARLS) conducted in 28 provinces across China was used. The pre-stroke frailty status was assessed using the Physical Frailty Phenotype (PFP) scale with the 2015 wave data. The PFP scale consisted of five criteria with a total score of 5, and categorized into non-frail (0 point), prefrail (1 and 2 points), and frail (3 or more points). Covariates included demographic factors (age, sex, marital status, residence, and education level) and health-related variables (comorbidities, self-reported health status and cognition). Activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed as the functional outcomes, with difficulties in at least one of the 6 ADL items and 5 IADL items defined as ADL/IADL limitation respectively. A logistic regression model was used to estimate the associations. ResultsA total of 666 participants who were newly diagnosed with stroke during the 2018 wave were included. 234 (35.1%) participants were classified as non-frail, 380 (57.1%) participants were classified as prefrail, and 52 (7.8%) participants were classified as frail. Pre-stroke frailty was significantly associated with ADL and IADL limitations post stroke. Additional significant variables with ADL limitation were age, female and more comorbidities. Additional significant variables with IADL limitation were age, female, married or cohabitating, more comorbidities and pre-stroke lower global cognitive score. ConclusionFrailty status was associated with ADL and IADL limitations after stroke. A more comprehensive assessment of frailty in older people may help to identify those with most significant risk for declining functional capacities after stroke and to develop appropriate intervention strategies.

A single-center prospective study regarding time to return to activities of daily living after craniotomy for brain tumors.

There are few studies on the time to return to activities of daily living (ADL) after craniotomy in patients with brain tumors. This study aimed to investigate the duration before returning to ADLs after craniotomy for brain tumors and present data that can provide information and guidelines on the appropriate time needed. Patients (n = 183 of 234) who underwent craniotomy for brain tumors between April 2021 and July 2021 capable of self-care upon discharge were enrolled, and data of 158 were collected. The start time of 85 ADL items was prospectively investigated for 4months postoperatively, using the self-recording sheet. Over 89% and 87% of the patients performed basic ADL items within a month and instrumental ADL items within 2months (medians: within 18days), except for a few. Regarding work, 50% of the patients returned within 4months. Washing hair with a wound was performed at 18days of median value, after 4months of dyeing/perming hair, 6days of drinking coffee/tea, after 4months of air travel, and 40days of complementary and alternative medicine. In patients with infratentorial tumors or surgical problems, return times were much later for various items. It is possible to provide practical information and guidelines on the duration to return to ADL after craniotomy in brain tumor patients. These study findings also reduce uncertainty about recovery and daily life and help patients return to their daily life at the appropriate time, thereby maintaining function and daily well-being after surgery.

Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

An ageing population coupled with an increase in morbidity places a considerable burden on health and social care systems. The aim of our study was to estimate the trends in functional dependency and project future care needs for older people in China. We analysed data from the China Health and Retirement Longitudinal Study, a nationally representative survey of a cohort of Chinese people (aged ≥45 years) from 150 counties or districts and 450 villages or urban communities across 28 provinces, who were selected by use of multistage stratified probability-proportionate-to-size sampling. The baseline survey was conducted in 2011 and follow-up surveys were conducted in 2013, 2015, 2018, and 2020. We excluded people younger than 60 years or people who had missing variables on dependency in the five follow-up interviews. Three dependency levels were determined on the basis of activities of daily living (ADLs) and instrumental activities of daily living (IADLs): any ADL items (level 1 dependency); any ADL items or difficulty cooking, shopping, or taking medications (level 2 dependency); and difficulty in any ADL or IADL items (level 3 dependency). The dependency rates were extrapolated to derive the number of people older than 60 years with dependency in China from 2011 to 2020. We used a regression model to project future changes and forecast the size of the older population with dependency between 2021 and 2030. A total of 89 031 individuals across five waves completed the surveys, of whom 46 619 were eligible for inclusion. The prevalence of level 1 dependency among older Chinese adults declined from 11·7% (95% CI 10·6-12·8) in 2011 to 8·1% (7·5-8·7) in 2020. Level 2 and level 3 dependency also declined. The total number of older people requiring care in 2020 was 20·61 million (95% CI 19·01-22·20) with level 1 dependency, 36·33 million (34·27-38·40) with level 2 dependency, and 45·30 million (43·02-47·59) with level 3 dependency. Improved education, housing, and access to health care was associated with 41·84% of the decline in level 3 dependency prevalence between 2011 and 2020. By 2030, the projected dependency rates could decline to 8·04% for level 1 dependency, 13·28% for level 2 dependency, and 16·05% for level 3 dependency. Nonetheless, the cohort size will grow, resulting in more older Chinese people who need care (29·71 million [27·07-32·36] in level 1, 49·07 million [45·98-52·16] in level 2, and 59·32 million [55·94-62·70] in level 3) in 2030. By 2030, we estimate that 14·02 million more older Chinese people will need care than in 2020. Rapid ageing of the population could offset the decline in dependency and result in a substantial increase in the population with complex care needs. Promoting healthy ageing and investing in an age-friendly environment are important in reducing care burdens in China. National Institute on Aging, Natural Science Foundation of China, China Medical Board. For the Chinese translation of the abstract see Supplementary Materials section.

Relationship between psychiatric symptoms and activities of daily living in patients undergoing hemodialysis

BackgroundAccurately identifying the factors contributing to decline in activities of daily living (ADL) is important for preventing such decline in patients undergoing hemodialysis (HD). We studied the prevalence and number of overlapping psychiatric symptoms (depressive symptoms, apathy, and sleep disturbance) in patients undergoing HD and examined the relationship between psychiatric symptoms and ADL.MethodsThe study utilized a cross-sectional research design. The sample included 203 outpatients (median age: 69 years) undergoing stable HD treatment three times a week. Patient characteristics, including age, sex, body composition, dialysis vintage, primary kidney disease, comorbidity, and nutritional status, were collected from patients’ medical records. Functional status was assessed based on the self-reported questionnaire that combined five basic and eight instrumental ADL items. Usual walking speed was used as an index of physical function. Additionally, the short version of the Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Further, apathy and sleep disturbance were assessed using the Motivation Score and the Athens Insomnia Scale, respectively.ResultsOverall, 59 (29.1%) patients demonstrated depressive symptoms, 100 (49.3%) reported apathy, 83 (40.9%) had sleep disturbance, 31 (15.3%) had three overlapping psychiatric symptoms, 43 (21.2%) had two overlapping psychiatric symptoms, 63 (31.0%) had only one symptom, and 66 (32.5%) had no psychiatric symptoms. Multiple logistic regression analysis showed that having two or three overlapping psychiatric symptoms was independently and significantly associated with ADL (functional status of 13 points for the ADL maintenance group, and of < 13 points for the ADL decline group, respectively), even after adjusting for patient characteristics and walking speed (odds ratio: 2.74, 95% confidence interval: 1.12–6.69, reference; no psychiatric symptoms).ConclusionThe present study clarified that the overlapping symptoms, including depressive symptoms, apathy, and sleep disturbance, were independently associated with ADL decline in patients undergoing HD. It is useful to examine not only depressive symptoms but also other symptoms such as apathy and sleep disturbance to elucidate factors associated with deteriorated ADL in chronic patients. Our findings provide a strong basis for targeted interventions to prevent functional dependence in the HD population.

Characteristic of process analysis on instrumental activities of daily living according to the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease.

To clarify the characteristic of impaired and unimpaired Instrumental Activities of daily living (IADL) processes with the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease (AD) using the Process Analysis of Daily Activity for Dementia (PADA-D). Cross-sectional study. 13 medical and care centers in Japan. 115 community-dwelling older adults with AD. The severity of cognitive impairment was classified by Mini-Mental State Examination (20 ≥ mild group, 20 < moderate group ≥ 10, 10 < severe group), and IADL scores and eight IADL items in PADA-D were compared among three groups after adjusting for covariates. Rate of five feasible processes included in each IADL of PADA-D was compared. IADL score showed a decrease in independence with the severity of AD except for Use modes of transportation and Managing finances, which was especially pronounced in Shopping (F = 25.58), Ability to use the telephone (F = 16.75), and Managing medication (F = 13.1). However, when the PADA-D was examined by process, some processes that were impaired and unimpaired with the severity of cognitive impairment were clear. For example, Plan a meal was impaired (ES = 0.29) with the severity, but Prepare the food was not in Cooking performance. We suggested that detailed process analysis in IADLs can clarify the characteristic of processes that are impaired and unimpaired with the severity of cognitive impairment in older adults with AD living in the community. Our findings may be useful for rehabilitation and care in IADL to continue living at home.

Instrumental activities of daily living, amyloid, and cognition in cognitively normal older adults screening for the A4 Study.

IntroductionWe examined the associations among instrumental activities of daily living (IADL), cortical amyloid, and cognition in cognitively normal (CN) older adults.MethodsCN participants screening for the A4 Study (n = 4486) underwent florbetapir (amyloid) positron emission tomography. IADL were assessed using the Alzheimer's Disease Cooperative Study Activities of Daily Living Prevention Instrument. Separate logistic regression models were run with cortical amyloid or cognition as independent variable and IADL as dependent variable, adjusting for age and sex.ResultsIADL difficulties were endorsed infrequently (≤16%). Overall IADL and four select IADL item difficulties (“remembering appointments,” “finding belongings,” “following TV programs,” and “remembering current events”) reported by both participant and study partner were significantly associated with greater amyloid burden and worse cognition.DiscussionAlthough IADL deficits were infrequent in this CN cohort, greater participant and study partner report of overall IADL deficits and subtle difficulties in specific IADL items were associated with mildly higher amyloid burden and worse cognition.

Why Do Older Korean Adults Respond Differently to Activities of Daily Living and Instrumental Activities of Daily Living? A Differential Item Functioning Analysis.

ObjectivesCulture-based gender norms regarding who performs daily activities can bias the assessment of instrumental activities of daily living (IADL). This study evaluated item-response biases in the activities of daily living (ADL) and IADL among community-living Korean older adults.MethodsThe subjects included older Korean participants of the Korean Longitudinal Study of Ageing baseline survey (n=4,164). We performed differential item functioning (DIF) analysis of these data using the Mantel–Haenszel method. ResultsWe observed different reported levels of disability for eight IADL items among gender, age, and educational level subgroups. After matching for overall functional disability, men were more likely to report limitations in performing various household activities, compared to cognitive activities in women.ConclusionsCross-national comparisons of ADL and IADL disabilities need to consider item response bias stemming from culture-based gender norms regarding who performs different household activities.

FREE TRANSPORTATION SERVICE RECIPIENTS MAY HAVE BETTER QUALITY OF LIFE BUT STILL LACK IN IMPROVING HEALTH

This study aimed to determine if service recipients (SRs) of free transportation services experience better quality of life, health, and function compared to pre-service recipients (PSRs). We conducted a cross-sectional study using personal interviews with 43 PSRs and 30 SRs belonged to a volunteer organization. Outcome measures were Older People’s Quality of Life (QoL), Center for Epidemiology Study-Depression, and Instrumental Activities of Daily Living (IADL). Total sample (N=73) had a mean age of 78.5 years and mostly female (86.3%). The majority of PSRs wanted to go to Drs’ offices (74.4%) and Grocery stores (60.5%), followed by Drug stores (44.2%), when the service becomes available. The figures were substantially smaller among SR (40.0%, 30%, and 13.3%, respectively). In PSRs, 67.4% expected to improve health once they start receiving the service, and 70. 0% of SRs said it did with the service. Using independent t-tests, SRs were significantly better in depression (p<.001), IADL (p=0.29) and most QoL items (life overall, social relationship, home and neighborhood, psychological and emotional well-being and leisure and activities; p=.047-p=.001), except for perceived health and finance. SRs (100%) were very satisfied with the service and drivers, but 80% of SRs said they wished to use more driving services than the allowable four times per month maximum. This limitation was due to the insufficient number of volunteers compared to a large number of people in need. Availability of more volunteer drivers will likely improve SRs health. Effective approaches to increase the number of driving volunteers are necessary.

Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older

BackgroundQuality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life.MethodsA total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension.ResultsAll ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item “stand up from sitting in a chair”, and IADL items “do “heavy” household activities” and “do the shopping” were negatively associated with both quality of life dimensions after controlling for all the variables in the model.DiscussionThis study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.

Criterion-Referenced Values of Grip Strength and Usual Gait Speed Using Instrumental Activities of Daily Living Disability as the Criterion.

Current evidence suggests that grip strength and usual gait speed (UGS) are important predictors of instrumental activities of daily living (IADL) disability. Knowing the optimum cut points of these tests for discriminating people with and without IADL disability could help clinicians or researchers to better interpret the test results and make medical decisions. The purpose of this study was to determine the cutoff values of grip strength and UGS for best discriminating community-dwelling older adults with and without IADL disability, separately for men and women, and to investigate their association with IADL disability. We conducted secondary data analysis on a national dataset collected in the Sarcopenia and Translational Aging Research in Taiwan (START). The data used in this study consisted of health data of 2420 community-dwelling older adults 65 years and older with no history of stroke and with complete data. IADL disability was defined as at least 1 IADL item scored as "need help" or "unable to perform." Receiver operating characteristics analysis was used to estimate the optimum grip strength and UGS cut points for best discriminating older adults with/without IADL disability. The association between each physical performance (grip strength and UGS) and IADL disability was assessed with odds ratios (ORs). With IADL disability as the criterion, the optimal cutoff values of grip strength were 28.7 kg for men and 16.0 kg for women, and those for UGS were 0.76 m/s for men and 0.66 m/s for women. The grip strength test showed satisfactory discriminant validity (area under the curve > 0.7) in men and a strong association with IADL disability (OR > 4). Our cut points using IADL disability as the criterion were close to those indicating frailty or sarcopenia. Our reported cutoffs can serve as criterion-referenced values, along with those previously determined using different indicators, and provide important landmarks on the performance continua of older adults' grip strength and UGS. These landmarks could be useful in interpreting test results, monitoring changes in performance, and identifying individuals requiring timely intervention. For identifying older adults at risk of IADL disability, grip strength is superior to UGS.

Prevalence of loss of activities of daily living and influencing factors in elderly population in China

Objective: To investigate the prevalence of the loss of basic activities of daily living (ADL) and instrumental ADL (IADL) influencing factors in the elderly population in China and provide evidence for the effective keeping and improvement of the elderly daily living. Methods: The information about demographic characteristics and activities of daily living of elderly Chinese aged ≥60 years were collected by using the data of 2013 China Health and Retirement Longitudinal Study. The elderly's ADL of taking bath, eating, getting in and out of bed, dressing, toilet use, and defecating and the IADL of doing housework, cooking, making phone call, taking medicine, shopping and money managing were evaluated. The differences in loss of ADL among different populations were compared by χ2 test and logistic regression analysis was conducted to identify influencing factors for the loss of ADL and IADL. Results: The overall ADL loss rate was 23.8% and the overall IADL loss rate was 35.4% in elderly Chinese. The proportion of having trouble in toilet use was highest among all ADL items, followed by bathing and getting in and out of bed. The proportion of having trouble in making phone call was highest among all IADL items, followed by doing housework and money managing. Female, older age, low educational level, living in central and western China, chronic diseases and disability were factors associated with ADL loss and IADL loss; the divorced or separated, widowed were more likely to have ADL loss; people living in rural area were more likely to have IADL loss. Conclusion: It is necessary to take comprehensive measures to delay and reduce the ADL and IADL loss in elderly Chinese and provide timely and appropriate health care for the elderly with ADL or IADL loss.

Understanding non-performance reports for instrumental activity of daily living items in population analyses: a cross sectional study.

BackgroundConcerns about using Instrumental Activities of Daily Living (IADLs) in national surveys come up frequently in geriatric and rehabilitation medicine due to high rates of non-performance for reasons other than health. We aim to evaluate the effect of different strategies of classifying “does not do” responses to IADL questions when estimating prevalence of IADL limitations in a national survey.MethodsCross-sectional analysis of a nationally representative sample of 13,879 non-institutionalized adult Medicare beneficiaries included in the 2010 Medicare Current Beneficiary Survey (MCBS). Sample persons or proxies were asked about difficulties performing six IADLs. Tested strategies to classify non-performance of IADL(s) for reasons other than health were to 1) derive through multiple imputation, 2) exclude (for incomplete data), 3) classify as “no difficulty,” or 4) classify as “difficulty.” IADL stage prevalence estimates were compared across these four strategies.ResultsIn the sample, 1853 sample persons (12.4 % weighted) did not do one or more IADLs for reasons other than physical problems or health. Yet, IADL stage prevalence estimates differed little across the four alternative strategies. Classification as “no difficulty” led to slightly lower, while classification as “difficulty” raised the estimated population prevalence of disability.ConclusionsThese analyses encourage clinicians, researchers, and policy end-users of IADL survey data to be cognizant of possible small differences that can result from alternative ways of handling unrated IADL information. At the population-level, the resulting differences appear trivial when applying MCBS data, providing reassurance that IADL items can be used to estimate the prevalence of activity limitation despite high rates of non-performance.

Detection of frailty in elderly cancer patients: Improvement of the G8 screening test

The G8 is a screening test to identify frail elderly patients with cancer. Objectives were to design and evaluate the performance of alternative tests taking into account other predictive domains for frailty. We conducted a literature review to identify predictive factors of frailty. Using a Delphi consensus, we collected 24 European experts' opinions to validate the most relevant items to improve the G8. Alternative tests were created and performance assessed on a development population (ONCODAGE cohort). The highest performing test was compared to the G8, and validated through both an internal and an external population validation (Aquitaine Geriatric Oncology cohort). The study population consisted of 1435 patients (ONCODAGE cohort) and 364 patients (Aquitaine Geriatric Oncology cohort). Twenty-three experts validated two items with a strong consensus (>75%): modification of the threshold for the G8 polypharmacy item to six drugs per day and replacement of the G8 item on neuropsychological problems by four Instrumental Activities of Daily Living (IADL) items predictive of incident dementia, creating three modified G8 tests (addition of either item, or both). Only the G8 IADL-modified test had better performance than the G8 when tested on the ONCODAGE cohort: sensitivity=77%, specificity=67%. This test was validated on the internal (sensitivity=78%, specificity=71%) and external (sensitivity=88%, specificity=69%) validation populations. Adding the four IADL items improves the performance of the G8. We have developed and validated a G8-modified test that is more specific than the G8 to detect frail elderly, while still sensitive and feasible in less than 10 min.

Patient Mood and Instrumental Activities of Daily Living in Alzheimer Disease: Relationship Between Patient and Caregiver Reports.

This retrospective study investigated the relationship between self-reports and caregiver perceptions of patients' depressive symptoms and the respective ability of these reports to predict instrumental activities of daily living (IADLs) beyond what is accounted for by cognitive abilities in 71 patients with mild Alzheimer disease. Patients completed the Geriatric Depression Scale-Short Form, and caregivers completed the Behavior Rating Scale for Dementia assessing their perception of patients' depressive symptoms. Caregivers also completed IADL items from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory. Cognitive measures included the Mini-Mental State Examination, Logical Memory from the Wechsler Memory Scale III, and Trail Making Test, Part B. The relationship between self-reported depressive symptoms and caregiver report of patients' depressive symptoms showed a trend toward significance (r = .22, P = .06). Measures of depressive symptoms significantly predicted 12.5% of the variance in IADLs performance, beyond that accounted for by patient demographics and cognitive functioning. Interestingly, patients' reports, rather than caregivers', were particularly useful in this prediction.

Factors influencing sex differences in poststroke functional outcome.

Our objective was to identify factors that contribute to or modify the sex difference in poststroke functional outcome. Ischemic strokes (n=439) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2008-2011). Data were ascertained from interviews (baseline and 90 days post stroke) and medical records. Functional outcome was measured as an average of 22 activities of daily living (ADL)/instrumental ADL items (range, 1-4; higher scores worse function). Tobit regression was used to estimate sex differences and to identify confounding and modifying factors. Fifty-one percent were women. Median age was 71 (interquartile range, 59-80) years in women and 64 (interquartile range, 56-77) years in men. Median ADL/instrumental ADL score at 90 days was 2.7 (interquartile range, 1.8-3.6) in women and 2.0 (interquartile range, 1.3-3.1) in men (P<0.01); this difference remained after age-adjustment (P<0.001). Factors contributing to higher ADL/instrumental ADL scores in women included prestroke function, marital status, prestroke cognition, nursing home residence, stroke severity, history of stroke/transient ischemic attack, and body mass index; prestroke function was the largest contributor. Stroke severity modified the sex difference in outcome such that differences were apparent for mild to moderate but not severe strokes. After adjustment, women still had significantly worse functional outcome than men. These findings yield insight into possible strategies and subgroups to target to reduce the sex disparity in stroke outcome; demographics and prestroke and clinical factors explained only 41% of the sex difference in stroke outcome highlighting the need for future research to identify modifiable factors that contribute to sex differences.

Assessment of an Expanded Functional Disability Scale for Older Adults With Diabetes.

Although prior literature has shown the plausibility of combining the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) items to form an expanded scale for measuring the degree of functional decline, this has not been shown in older adults with diabetes who are disproportionately affected by functional disability. Using the 2009 Medicare Current Beneficiary Survey data, we evaluated the factor structure of the pooled ADL and IADL items. Based on our study comprising 2,158 community-dwelling older adults (≥65 years) with diabetes, the unidimensional model exhibited good fit. Despite well-fitting indices, high correlations were observed between the latent constructs (>.70) of the multi-factor models, suggesting a lack of discriminant validity. These findings provide empirical support for a combined scale that can comprehensively and efficiently characterize the extent of functional disability in older adults with diabetes for research, risk adjustment, and evaluation in patient-centered medical homes.